Chest
Volume 133, Issue 4, April 2008, Pages 887-891
Journal home page for Chest

Original Research
Interventional Pulmonology
Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration of Lymph Nodes in the Radiologically and Positron Emission Tomography-Normal Mediastinum in Patients With Lung Cancer

https://doi.org/10.1378/chest.07-2535Get rights and content

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can reliably sample enlarged mediastinal lymph nodes in patients with non-small cell lung cancer (NSCLC), and in practice is mostly used to sample nodes visible on CT or positron emission tomography (PET). Few data are available on the use of endoscopic procedures to stage the mediastinum in clinical stage 1 lung cancer. The aim of the present study was to determine the results of EBUS-TBNA in sampling mediastinal lymph nodes in patients with lung cancer and a radiographically normal mediastinum and no PET activity.

From January 2004 to May 2007, patients highly suspicious for NSCLC with CT scans showing no enlarged lymph nodes (no node > 1 cm) and a negative PET finding of the mediastinum underwent EBUS-TBNA. Identifiable lymph nodes at locations 2r, 2L, 4r, 4L, 7, 10r, 10L, 11r, and 11L were aspirated. All patients underwent subsequent surgical staging. Diagnoses based on aspiration results were compared with those based on surgical results.

One hundred patients (mean age, 52.4 years; 59 men) were included. After surgery, 97 patients (mean age, 52.9 years; 57 men) had NSCLC confirmed and were included in the analysis. In this group, 156 lymph nodes ranging 5 to 10 mm in size were detected and sampled. Malignancy was detected in nine patients but missed in one patient. Mean diameter of the punctured lymph nodes was 7.9 mm. The sensitivity of EBUS-TBNA for detecting malignancy was 89%, specificity was 100%, and the negative predictive value was 98.9%. No complications occurred.

In conclusion, EBUS-TBNA can be used to accurately sample and stage patients with clinical stage 1 lung cancer and no evidence of mediastinal involvement on CT and PET. Potentially operable patients with no signs of mediastinal involvement may benefit from presurgical staging with EBUS-TBNA.

Section snippets

Materials and Methods

The protocol of this study was approved by the local institutional review board. All patients provided written informed consent. Between January 2004 and May 2007, consecutive patients with an indication for bronchoscopy and suspicion for NSCLC were screened for inclusion in the study. All patients did undergo a CT scan of the chest (plain and contrast enhanced) and a PET scan as part of their standard workup. Only patients without CT evidence of enlarged mediastinal lymph nodes as well as

Results

In total, 1,217 patients were evaluated until 100 patients were identified meeting criteria. Mean age was 52.4 years, and 59 were men. As stipulated, CT and PET showed evidence suggesting a tumor originating from the lung suspicious for NSCLC, without enlarged mediastinal lymph nodes and without mediastinal PET activity in all patients.

After diagnostic procedures, 97 patients were confirmed to have NSCLC (59 adenocarcinoma, 29 squamous cell cancer, and 9 adenosquamous cell cancer). This group

Discussion

In a previous published trial,19 we used EBUS-TBNA in a comparable setting. Overall, 17 patients had stage N2 or N3 disease, of which 16 cases were identified from EBUS-TBNA, and 4 patients had stage N1 disease, of which 3 cases were identified by EBUS-TBNA. The sensitivity, specificity, and negative predictive value of EBUS-TBNA for detecting malignancy were 92.3%, 100%, and 96.3%, respectively. A limitation of the study was the lack of routine PET scanning. Because PET scanning is becoming

Conclusions

The current findings suggest that EBUS-TBNA should be considered in the preoperative staging of all patients with and without mediastinal lymph node enlargement on CT scan and with or without PET activity in the mediastinum. EBUS TBNA could be an obvious choice for the primary procedure because it is well tolerated, carries minimal morbidity, and allows for additional pulmonary procedures in the same setting. Further studies are needed to compare the different invasive and noninvasive staging

References (34)

  • YS Choi et al.

    Mediastinoscopy in patients with clinical stage I non-small cell lung cancer

    Ann Thorac Surg

    (2003)
  • MB Wallace et al.

    Endoscopic ultrasound in lung cancer patients with a normal mediastinum on computed tomography

    Ann Thorac Surg

    (2004)
  • JK LeBlanc et al.

    Endoscopic ultrasound in non-small cell lung cancer and negative mediastinum on computed tomography

    Am J Respir Crit Care Med

    (2005)
  • T Funatsu et al.

    Preoperative mediastinoscopic assessment of N factors and the need for mediastinal lymph node dissection in T1 lung cancer

    J Thorac Cardiovasc Surg

    (1994)
  • A Spira et al.

    Multidisciplinary management of lung cancer

    N Engl J Med

    (2004)
  • JJ Erasmus et al.

    Positron emission tomography imaging in nonsmall-cell lung cancer

    Cancer

    (2007)
  • N Al-Sarraf et al.

    Lymph node staging by means of positron emission tomography is less accurate in non-small cell lung cancer patients with enlarged lymph nodes: analysis of 1145 lymph nodes

    Lung Cancer

    (2008)
  • Cited by (316)

    • Endobronchial Ultrasound for Mediastinal Staging in Lung Cancer

      2021, Encyclopedia of Respiratory Medicine, Second Edition
    View all citing articles on Scopus

    The institutions or affiliated medical schools of the authors have received unrestricted grant support from Olympus Corporation for continuing medical education activities, and the endobronchial ultrasound imaging components are on loan in the institutions. The authors have not received any direct financial support.

    View full text